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Thumb Sprain

A thumb sprain is a stretch or tear of a ligament located at one of the thumb joints. This traumatic injury is common, and athletes in sports such as skiing, football, and wrestling are frequently affected. In fact, in skiers, only the knee is injured more often than the thumb. This condition not only leads to time lost from sports until it is healed, but it also creates the potential for future disability if it is not properly identified and treated.

Thumb sprains can occur at any of the three thumb joints. A thumb sprain however, is synonymous with an injury to the inside ligament (ulnar collateral ligament, UCL) at the middle joint (metacarpophalangeal, MCP) of the thumb. Multiple names are used to describe UCL sprains, including “gamekeeper's thumb” and “skier's thumb.” The term gamekeeper's thumb was coined after Scottish gamekeepers (ca. 1955) were found to be prone to these particular thumb sprains. Their repetitive practice of breaking the necks of small game by holding the animal in the web space between their thumb and pointer finger would injure the UCL. In recent times, this injury has been more commonly referred to as skier's thumb. Relatively frequent trauma and subsequent falls create a strong correlation between skiers and thumb sprains.

Anatomy

The thumb is composed of three bones and three joints. The bones of the thumb are the metacarpal, proximal phalanx, and distal phalanx. The metacarpal bone is the one closest to the wrist, the distal phalanx is at the tip of the thumb, and the proximal phalanx lies between these two bones. Connecting the thumb bones from the wrist to the tip of the thumb are the carpometacarpal (CMC), MCP, and interphalangeal (IP) joints, in that order. At each joint, there are multiple ligaments that provide stability to the thumb when traumatic or pinching forces are placed on it. They are the collateral ligaments, the volar plate, and the joint capsule. The collateral ligaments are located on the inner and outer sides of each thumb joint and provide side-to-side stability. The UCL is the collateral ligament closest to the little finger, and the radial collateral ligament (RCL) lies on the opposite side of the joint from the UCL. The volar plate is a ligament located on the palm side of each thumb joint and prevents hyperextension. Finally, the joint capsule is a saclike envelope that encloses the entire joint.

Type of Injury

The majority of thumb sprains occur at the UCL of the MCP joint. The second most common sprain occurs at the RCL of the MCP joint. The IP joint infrequently experiences ligament injury. Rarely are there isolated injuries to the CMC joint. The ligaments at this joint are well protected from trauma. Certainly, fractures and dislocations are associated with ligament sprains, but they are beyond the scope of this entry.

Clinical Evaluation

History

There are numerous traumatic mechanisms that can cause a thumb sprain. All, however, involve a side-to-side force that creates extreme thumb movement either toward or away from the hand. The collateral ligaments are naturally affected as they provide side-to-side stability at the thumb joints. Typical examples of these movements are a fall while holding a ski pole or a fall onto an outstretched and extended thumb.

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